Chapter 3: Naloxone Access and 911 Medical Amnesty (1/2)

Having used heroin for over six years before becoming involved with overdose prevention, when I started doing research to get overdose prevention laws passed in my state, some facts didn’t surprise me. Others blew my mind.

I knew how frightened heroin and prescription pain pill users were to call for help when a friend overdosed. I’d heard stories of trying bystanders trying to revive overdose victims by splashing cold water on their face, dragging them into a cold shower, injecting them with saltwater, smacking them in the face, sticking Suboxone under their tongue, and so on. All of these are unlikely to work, and sometimes might make a situation more dangerous. (And, of course, there’s that infamous scene from Pulp Fiction that’s been the bane of overdose prevention efforts since the mid-90s: No, you cannot revive someone from a heroin overdose with a shot of adrenaline to the heart!)

Interestingly, I rarely heard stories of friends calling 911 or taking victims to the hospital (although one friend came very close to doing this for me when I had a close call). In their minds, at least, there was good reason for this: Everyone heard tales of that friend-of-a-friend who dropped someone off at the ER only to be arrested on the spot.

In my research I found that police didn’t arrest bystanders at overdose scenes nearly as much as people suspected; but just the thought of a police encounter, the fear of going to jail, of having to kick cold turkey, and–if you were on parole or probation–a lengthy prison term, was a strong deterrent to calling for help.

Overdose statistics in the US are mind-blowing, and they’ve increased exponentially over the last 15 years. Drug overdose is now the number one cause of accidental death (around 44,000/year, with automobile accidents coming in second, at 33,000). According to the Centers for Disease Control (CDC), between 2001-2013, heroin overdose deaths increased 500%. Overdose deaths from prescription painkillers increased 300%. And overdose deaths from benzodiazepines (Xanax, Ativan, and Klonopin, etc.) increased 400%.

These numbers are unacceptable. At first I didn’t know what to make of the numbers. In my home state of Georgia, overdose numbers were particularly difficult to track because of the way they were reported (metro Atlanta counties had their method, counties in the rest of the state had another).

The only thing that mattered to me was that my closest friend had just died from a heroin overdose because someone was scared to call for help. At Georgia’s first Overdose Awareness Vigil I heard story after story just like his. It was clear something had to change.

911 medical amnesty laws and naloxone access laws aim to address these problems. Here’s a brief summary of each:

911 Medical Amnesty: These laws provide legal immunity from arrest, prosecution, or conviction when someone calls to report an overdose and police show up, where they might find small amounts of drugs. The person who calls and the victim are generally protected. In some states, everyone at the scene is protected. Laws vary from state-to-state, with some states even providing protection for those with active arrest warrants preventing probationers and parolees from having their term violated. Some states also include underage alcohol provisions.

Naloxone Access: Naloxone is a medication that can almost always reverse an overdose from heroin and other opiates when administered in time. For many years, only EMTs and emergency rooms had access. These laws make it legal for anyone to carry naloxone and provide legal civil and criminal amnesty for unintended results when administering naloxone in good faith (although naloxone is almost 100% harmless when used on healthy adults) It has no recreational value and, when administered to opiate-dependent people, causes immediate withdrawal (which, in the case of an overdose is a good thing).

Before naloxone access laws were enacted (and many states still don’t have them), harm reduction groups distributed naloxone to at-risk communities despite the legal status. Sometimes those of us at the front line of the “War on Drugs” resort to “extralegal” means to save lives.

Naloxone has been used for decades by EMTs and emergency rooms to save lives. Thanks to these new laws, it’s now saved thousands of lives out in the streets.

There’s room for optimism with 911 medical amnesty laws. With more states passing them, it seems inevitable that, within the next few years, all states will provide some level of medical amnesty. But some problems still remain:

  1. Many active drug users don’t know about these laws. We need to find ways to erase myths and get accurate information into their hands. Families can help by talking about these laws with loved ones, but sometimes that’s not enough. These laws should be discussed at every point of contact with active and recovering drug users. I think methadone clinics are an ideal place to start. Patients in these programs often maintain ties to active users and, based on my experience, word travels fast in these circles.
  2. We need consistency between laws at a national level. Some states provide very little protection–for only the victim and caller, and for very small amounts of drugs. Others provide protection for victims, callers, and bystanders with active warrants or who are on probation and parole. Consistency and clarity in how these laws are written and implemented is crucial to educating at-risk communities and eradicating misconceptions that might still prevent someone from calling 911 or administering naloxone.

We’ll continue this discussion tomorrow, considering steps we can take to improve existing laws, find more effective ways of educating at-risk communities, getting naloxone to the people who need it most, and looking at innovative approaches save lives and reduce harm both, from a policy perspective and at the grassroots level.

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